What are the First Signs of Cirrhosis of the Liver?

Reviewed By: Pramod Kerkar, MD, FFARCSI

Generally, the signs and symptoms of liver cirrhosis appear when there is extensive damage to the liver parenchyma. The signs and symptoms appear due to the impairment of the normal functioning of the liver tissue. Liver cirrhosis is gradually progressing disease which can have various manifestations. The symptomology of liver cirrhosis can be either due to the direct effect of Liver cell damage or due to other pathologies associated with liver cirrhosis like portal hypertension. Cirrhosis of the liver is a gradual and progressive disease, which may take years to develop to such extent to notice. The absence of any signs does not rule out the possibility of liver cirrhosis. It is usually presented at an advanced stage because as the course of the disease is quite slow it takes years to get noticeable enough.

The signs and symptoms of liver cirrhosis arise due to the inability of the liver to perform its normal functioning like blood purification, metabolism of toxins, production of coagulation factors, metabolism of fat, carbohydrate.

What are the First Signs of Cirrhosis of the Liver?

The symptomatology of liver cirrhosis can be further divided into those due to

Primary impairment of the liver tissue functioning.

Effect of portal hypertension.

Symptoms Due to Liver Dysfunction

Jaundice- it is the yellowish discoloration of the skin and mucous membrane. It is resulted due to the high concentration of bilirubin in the blood. The color of urine also becomes dark yellow. Yellowing of the mucous membrane can be more appreciable on the Sclera.

Palmer Erythema- it is the reddening of the skin of thenar and hypothenar eminence of the palm. It is associated with increased level of estrogen.

Liver Size: Liver size may be enlarged, shrunken, or may be normal.

Ascites- it is the accumulation of fluid in the peritoneal cavity. On examination per abdomen, there is dullness over the flanks. On inspection, it is visible as an increase in the girth of the abdomen.

Gynecomastia- It is the development of mammary gland in Males. It is associated with the increased level of estrogens in plasma. It is the development of gland rather than the accumulation of fat which is normally seen in obese persons.

Hypogonadism - Decrease in the male sex hormones which are presented as impotence, decreased libido, and atrophy of testis. Hypogonadism is generally more commonly seen in cirrhosis due to alcoholism or hemochromatosis.

Symptoms Due To Portal Hypertension

Portal hypertension is the sequelae of liver cirrhosis. The pathological changes resulted due to the cirrhosis impedes the Blood circulation thus causing increased pressure in the portal circulation.

Normal portal blood pressure is 7-10 mm of Hg.

Splenomegaly- It is the increase in the size of the spleen. It is thought to be dry to increased pressure in splenic vein.

Caput Medusa- These are the dilated paraumbilical collateral veins due to portal hypertension. It is due to shunting of portal venous blood to paraumbilical veins, which finally drains to veins present in the abdominal wall. These abdominal walls get enlarged and manifest as the typical pattern which looks like Medusa.

Esophageal Varices- Due to increased venous pressure in the portal venous system there is the opening of collateral circulation in the stomach and esophagus. These enlarged blood vessels are called as varices. Due to enlargement of these vessels, their wall becomes thin and is more prone to get Rupture. Rupture of these blood vessels can lead to severe hemorrhage and may prove to be fatal.

In advance stage of disease, several complications may arise.

In advance stage of cirrhosis due to the involvement of large area of Liver, there is impairment of the normal functioning of the same viz. Production of coagulation factor is impaired leading to frequent bleeding and bruising.

Due to impairment of excretory function, there is retention of ammonia and other nitrogen-containing products which on reaching the level of the brain affects normal cerebral functioning, unresponsiveness, concentration deficit, sleep disturbances etc.

Conclusion

Liver cirrhosis is a long-standing disease, which takes years to develop. The signs and symptoms of the disease appear gradually and sometimes noticed when the disease is in the later stages. Jaundice is the symptom which along with detail history of patients can lead to diagnosis in the right direction.